Healthcare Provider Details

I. General information

NPI: 1942947320
Provider Name (Legal Business Name): ELIZABETH MARY VALK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH MARY REARDON

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 TROY SCHENECTADY RD STE 224
LATHAM NY
12110-2490
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-786-6270
  • Fax: 518-786-6276
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number349077
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: